Provider First Line Business Practice Location Address:
66-632 KAM HWY # 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALEIWA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96712-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-293-9221
Provider Business Practice Location Address Fax Number:
808-293-1574
Provider Enumeration Date:
08/26/2020